Is it more effective to have an organ donation system based on explicit consent or presumed consent?
Organ donation policies worldwide exhibit significant variations, prompting a debate over whether an opt-in or opt-out system would yield the best results. To shed light on this matter, a team of researchers from the University of Nottingham, UK, analyzed the organ donation protocols of 48 countries over a 13-year period.
In opt-in systems, individuals must actively register to donate their organs post-mortem, whereas opt-out systems assume consent for organ donation unless specifically requested not to before death. Prof. Eamonn Ferguson, the study's lead author, acknowledges that the reliance on individual decisions in both systems can result in certain drawbacks, such as procrastination, disregard, or the assumption that authorities have made the correct decision.
A challenge in opt-in systems is that individuals who may want to donate might not act, resulting in potential false negatives. In contrast, in opt-out systems, people who do not wish to donate might unintentionally become donors, producing false positives. At present, the US employs an opt-in system, which enabled 28,000 transplants last year. Unfortunately, around 18 people still die daily due to a scarcity of donated organs.
The researchers found, upon reviewing the annual organ donation data of 48 countries, that countries adopting an opt-out system had substantially higher numbers of kidney donations, an organ in high demand by recipients on the organ transplant list. Additionally, countries utilizing opt-out systems recorded considerably more overall organ transplants. Opt-in systems, however, featured a higher rate of living kidney donations.
Prof. Ferguson notes that their study has limitations, as it does not distinguish between the varying degrees of opt-out legislation in different countries. Furthermore, the observational nature of the research leaves other factors affecting organ donation unaddressed.
The authors urge that policy decisions could incorporate their findings in the future. They suggest collecting and publishing international organ donation information, such as consent type, procurement processes, and hospital bed availability, to bolster the robustness of their study. Prof. Ferguson also suggests further research to explore the opinions of individuals making the decision to opt-in or opt-out, using survey and experimental methods.
Countries adopting the opt-out system still encounter organ donor shortages. Hence, switching the entire system may not address the issue. Instead, they propose that modifying consent legislation or adopting parts of the "Spanish Model," which features a national transplant coordination network and improved public information about organ donation, could improve donor rates.
Spain maintains the world's highest organ donation rate. Experts attribute this success not only to the opt-out system but also to the transplant coordination network and enhanced information dissemination regarding organ donation. In a recent article, Medical News Today addressed the question of whether farming animal organs for human transplants could offer a solution to the organ shortage or if this issue should be tackled through policy changes in organ donation.
- Scientific findings indicate that countries operating under opt-out systems for organ donation show higher numbers of kidney donations, an organ in high demand, as well as increased overall organ transplant rates compared to opt-in systems.
- However, the research also acknowledges that the study has limitations, as it does not fully account for varying degrees of opt-out legislation in different countries and other contributing factors affecting organ donation.
- To enhance the study's robustness and inform future policy decisions, the authors advocate for greater international transparency regarding organ donation data, including consent type, procurement processes, and hospital bed availability.
- In an attempt to address ongoing organ donor shortages, countries adopting the opt-out system are suggested to consider modifications to the consent legislation or adopting elements of the "Spanish Model," which focuses on a national transplant coordination network and improved public education about organ donation.
